PDF(Pubmed)
Abstract：
Enhanced recovery after surgery (ERAS) protocols employ multiple factors to decrease surgical stress and improve recovery (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012). These protocols use multimodal approaches to improve outcomes, including length of stay and morbidities (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012; Carmichael et al., Dis Colon Rectum 60:761-784, 2017). The ERAS guidelines have evolved since development; however, the question is posed of how to improve next (Lyon et al., World J Gastroenterol 18(40):5661-5663, 2012). With the success of ERAS, in combination with milestones made by minimally invasive surgery (MIS), it is our aim to describe the next step of same day discharge colectomy. Retrospective review was performed on all colectomies from February 2019 to January 2022. Same day discharge (SDD) was defined as admission less than 23 h and no overnight stay. Procedures were nonemergent and MIS. Patients were candidates SDD based on comorbidities, communication means, and social support. SDD candidacy continued if surgery was uncomplicated. Next, patients were required to achieve strict Post Anesthesia Care Unit (PACU) criteria for discharge. SDD patients were monitored via calls or messages until their first appointment. After analysis, 326 total colectomies were identified; based on inclusion and exclusion criteria, 115 patients underwent SDD, 35.3%. Of the 115 SDD, 5 patients returned to the emergency department, only 1 required readmission (0.9%). The most performed procedures were low anterior resection, 61 (53.0%), and right hemicolectomy, 25 (21.7%). Using ERAS protocols as a groundwork to improve upon, we identified several ways to advance select patients into SDD. Using strict patient selection, intraoperative regulations, and rigorous postoperative criteria, we found that SDD as an advancement of ERAS is a relatively safe procedure with minimal complications.
摘要：
增强手术后恢复（ERAS）方案采用多种因素来减少手术压力并改善恢复（Lyon等人。,世界胃肠病杂志18(40):5661-5663,2012).这些协议使用多模式方法来改善结果，包括住院时间和发病率(里昂等人,世界胃肠病杂志18(40)：5661-5663，2012；Carmichael等人。,结肠直肠60：761-784，2017）。ERAS准则自发展以来一直在发展；然而，问题是下一步如何改进(里昂等人。,世界胃肠病杂志18(40):5661-5663,2012).随着ERAS的成功,结合微创手术(MIS)的里程碑，我们的目的是描述当天出院结肠切除术的下一步。从2019年2月至2022年1月，对所有结肠切除术进行了回顾性审查。当天出院（SDD）定义为住院少于23小时且无过夜。程序是非紧急的和MIS的。患者是基于合并症的SDD候选人，通信手段,和社会支持。如果手术不复杂，则继续接受SDD候选人资格。接下来,患者需要达到严格的麻醉后护理室(PACU)标准才能出院.SDD患者通过电话或消息进行监测，直到他们第一次预约。经过分析,总共确定了326例结肠切除术；根据纳入和排除标准，115名患者接受了SDD，35.3%。在115个SDD中,5名患者返回急诊科，只有1次需要再入院(0.9%)。执行最多的手术是低位前切除术，61（53.0%），和右半结肠切除术,25（21.7%）。使用ERAS协议作为改进的基础，我们确定了几种提前选择SDD患者的方法.通过严格的患者选择，术中规定，严格的术后标准，我们发现SDD作为ERAS的一种进步是一种相对安全的手术,并发症最少.
